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Insulin for dementia?

NAS80838

My wife has poorly controlled Type 2 along with worsening memory loss and now recurring UTI. Metformin, which she has been taking for 19 years, hasn't helped for a long time. Going for a new consult at a memory clinic on the 18th. There is evidence, however tenuous, that insulin, especially intranasal, can reduce symptoms. Any experiences to share regarding insulin and dementia? Thanks.

  • Scientifically, insulin influences cellular processes such as growth and survival and acts positively on neurons, so I guess insulin is good for dementia. Before starting consuming insulin, it is better to consult your doctor to see its recommendations. Or another choice could be to make an online memory test, which will show you the capacity of the memory in the short and medium term. You can use insulin to treat dementia without worries cause the memory potential can be improved in the detained thought of words.

  • No experience with insulin either, but piggybacking on this comment to add some diabetes practice guidelines from my wonderful primary care mentor:

    TIER 1: METFORMIN

    TIER 2: SGLT-2 inhibitors such as Empagliflozin, Canagliflozin, Dapagliflozin; some are in combination with metformin or DPP4 inhibitors, and those are even more expensive; GLP-1 agonists (only Semaglutide is oral, and is pretty expensive and hard to acquire too in the Philippines); other GLP-1 agonists like Liraglutide are available in combination with long-acting insulin

    TIER 3- DPP4-inhibitors- probably the safest and most tolerable but not the most efficacious and boasts less benefit for other organs like heart and kidney which are present in TIER 1 AND 2

    TIER 4- Thiazolidinediones (TZD), sulfonylureas-efficacious but notorious for causing hypoglycemia

    TIER 4 is preferred when there are financial constraints

    TZD- associated with weight gain and can worsen outcomes in patients with heart failure. Sulfonylureas are associated with poorer outcomes in patients with existing CVS disease.

    Taking a break from quoting my mentor, this is now me speaking as a medical student: I have yet to read a case on metformin refractoriness actually- esp. in the Philippines where clinical practice guidelines- maximize use of metformin. I can get back to you if I read something good.

    Going back to quoting the mentor: Metformin is only really avoided if there is allergy and poor tolerability, mostly due to vomiting, GI upset, diarrhea, etc.

    TIER 5 (last tier)- alphaglucosidase inhibitors, other drugs/interventions for obesity if present